Electroencephalogram pattern predicting neurological outcomes of children with seizures secondary to abusive head trauma

Cheng-Che Chou; Ju-Yin Hou; I-Jun Chou; Shih-Yun Lan; Shu-Sing Kong; Man-Hsu Huang; Yu-Chieh Weng; Yi-Yu Lin; Cheng-Yen Kuo; Meng-Ying Hsieh; Min-Liang Chou; Po-Cheng Hung; Huei-Shyong Wang; Kuang-Lin Lin; Yi-Shan Wang; Jainn-Jim Lin; Prevention, Protection Against Child Abuse, Neglect (PCHAN) Study Group

doi:10.1016/j.pedneo.2023.05.012

Electroencephalogram pattern predicting neurological outcomes of children with seizures secondary to abusive head trauma

Pediatr Neonatol. 2023 Oct 21:S1875-9572(23)00187-0. doi: 10.1016/j.pedneo.2023.05.012. Online ahead of print.

Authors

Cheng-Che Chou¹, Ju-Yin Hou², I-Jun Chou², Shih-Yun Lan³, Shu-Sing Kong⁴, Man-Hsu Huang⁵, Yu-Chieh Weng⁶, Yi-Yu Lin⁶, Cheng-Yen Kuo², Meng-Ying Hsieh², Min-Liang Chou², Po-Cheng Hung², Huei-Shyong Wang², Kuang-Lin Lin², Yi-Shan Wang², Jainn-Jim Lin⁷; Prevention, Protection Against Child Abuse, Neglect (PCHAN) Study Group

Affiliations

¹ Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan; Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taiwan.
² Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan.
³ Division of Pediatric Neurology, Department of Pediatrics, New Taipei City Hospital, New Taipei City, Taiwan.
⁴ Division of Pediatric Neurology, Department of Pediatrics, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
⁵ Department of Pathology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan.
⁶ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan. Electronic address: lin0227@cgmh.org.tw.

PMID: 38012896
DOI: 10.1016/j.pedneo.2023.05.012

Abstract

Background: The clinical presentations of abusive head trauma can abruptly worsen, so the occurrence of seizures and changes of EEG can be variable according to patients' conditions. Since the changes of EEG background waves reflect the cortical function of children, we aimed to find out whether the timing of EEG background, epileptiform discharges and seizure patterns were associated with the outcomes of patients with AHT.

Material and methods: Using seizure type and acute stage electroencephalographic (EEG) characteristics to assess adverse neurological outcomes in children with seizures secondary to abusive head trauma (AHT). Children who were hospitalized with AHT at a tertiary referral hospital from October 2000 to April 2010 were evaluated retrospectively. A total of 50 children below 6 years of age admitted due to AHT were included. KOSCHI outcome scale was used to evaluate the primary outcome and neurological impairment was used as secondary outcome after 6 months discharge.

Results: Children with apnea, cardiac arrest, reverse blood flow and skull fracture in clinic had a higher mortality rate even in the no-seizure group (3/5 [60%] vs. 3/45 [6.7%], odds ratio [OR] = 11; 95% CI = 2.3-52; p = 0.025). Seizure occurrence reduced mostly at the second day after admission in seizure groups; but children with persistent seizures for 1 week showed poor neurological outcomes. The occurrence of initial seizure was frequency associated with younger age; focal seizure, diffuse cortical dysfunction in acute-stage EEG, and low Glasgow Coma Scale (GCS) score were significantly related to poor outcomes after 6 months. Diffuse cortical dysfunction was also associated with motor, speech, and cognitive dysfunction.

Conclusions: Diffuse cortical dysfunction in acute-stage EEG combined with low GCS score and focal seizure may related to poor outcomes and neurological dysfunctions in children with AHT.

Keywords: Abusive head trauma; Brain injury; Child abuse; Electroencephalography; Outcome; Seizure.